Children who live with a substance-abusing father often manifest significant emotional, behavioral, and social problems. Although directly treating these children may be ideal, many parents are very reluctant to allow the child to take part in individual or family therapy. Preliminary research suggests that Learning Sobriety Together (LST;the """"""""brand"""""""" name of Behavioral Couples Therapy for alcohol and drug abuse), a comprehensive psychosocial intervention for substance abuse that focuses both on reducing substance abuse and improving couple functioning, may provide an entry point into the family system from which to benefit children in these homes. To address this we will conduct a randomized clinical trial (RCT) to compare the emotional and behavioral adjustment, beliefs about aggression, and serious negative behaviors of youth ages 8 to 16 (as rated from mothers, fathers, teachers, and children themselves) whose drug- abusing fathers and non-substance-abusing mothers take part in LST as compared to youth whose fathers take part in an equally intensive individual-based treatment (IBT). We will examine whether LST is associated with significantly higher levels of adjustment (e.g., fewer internalizing and externalizing symptoms, less acceptability of aggression, less delinquency, aggression/violence, and substance use) at post treatment and during the 12-month follow-up as compared to IBT;whether participation in LST will result in lower addiction severity, increase couple functioning, lower interparental conflict, improve parenting, reduce risk for child maltreatment, and improve parental psychological functioning as compared to IBT, whether changes in addition severity, dyadic adjustment, interparental conflict, parenting, and parental psychological adjustment during and after treatment will be associated with changes in children's adjustment;and whether changes in addiction severity, dyadic adjustment, interparental conflict, parenting, and parental psychological functioning will partially or fully mediate the direct effect of treatment condition (LST versus IBT) on youth outcomes. Finally, we will test a moderated-mediation hypothesis to determine whether adolescents experience a significantly weaker effect than preadolescents. We intend to use the information collected from the proposed study to refine and modify LST to enhance its positive effects on children and provide an option for agencies to support youth in these homes.

Public Health Relevance

Children of drug-abusing parents are at extremely high risk for a host of problems throughout childhood and into adulthood, yet their parents are reluctant to involve them in any treatment services. Empirically-based interventions are needed that can benefit not only the drug-abusing parent, but also extend further to the family system to improve their children's current psychosocial adjustment as they prepare for transitions to adulthood. Learning Sobriety Together holds great potential for having such broad and prolonged effects that will benefit families affected by drug abuse as well as the treatment community that serves them.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZDA1-MXS-M (09))
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Chambers, Jessica Campbell
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Old Dominion University
Schools of Arts and Sciences
United States
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Kelley, Michelle L; Bravo, Adrian J; Braitman, Abby L et al. (2018) Mental Health Symptoms and Parenting Among Father-Only and Dual Substance Use Disorder Couples. J Fam Issues 39:796-816
Kelley, Michelle L; Bravo, Adrian J; Hamrick, Hannah C et al. (2017) Parents' Reports of Children's Internalizing Symptoms: Associations with Parents' Mental Health Symptoms and Substance Use Disorder. J Child Fam Stud 26:1646-1654
Kelley, Michelle L; Bravo, Adrian J; Braitman, Abby L (2017) Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Youth Internalizing Symptoms. J Abnorm Child Psychol 45:731-741
Kelley, Michelle L; Braitman, Abby L; Milletich, Robert J et al. (2016) Acceptability of aggression among children who reside with substance-abusing parents: The influence of behavioral dysregulation, exposure to neighborhood violence, and interparental violence. J Child Custody 13:250-258
Braitman, Abby L; Kelley, Michelle L (2016) Initiation and retention in couples outpatient treatment for parents with drug and alcohol use disorders. Exp Clin Psychopharmacol 24:174-184
Kelley, Michelle L; Bravo, Adrian J; Braitman, Abby L et al. (2016) Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Risk for Child Abuse. J Subst Abuse Treat 62:10-9
Kelley, Michelle L; Lawrence, Hannah R; Milletich, Robert J et al. (2015) Modeling risk for child abuse and harsh parenting in families with depressed and substance-abusing parents. Child Abuse Negl 43:42-52
Kelley, Michelle L; D'Lima, Gabrielle M; Henson, James M et al. (2014) Substance-abusing mothers and fathers' willingness to allow their children to receive mental health treatment. J Subst Abuse Treat 47:106-11
Kelley, Michelle L; Klostermann, Keith; Doane, Ashley N et al. (2010) The Case for Examining and Treating the Combined Effects of Parental Drug Use and Interparental Violence on Children in their Homes. Aggress Violent Behav 15:76-82